妊娠期糖尿病结构化教育临床实践促进与阻碍因素分析  

Factors that promote and hinder clinical practice of structured education in gestational diabetes mellitus

作　　者：孙月萍 周蓉[1] 蒙莉萍 郭亚琼 张彩虹[1] 郭洪花[1] SUN Yueping;ZHOU Rong;MENG Liping;GUO Yaqiong;ZHANG Caihong;GUO Honghua

机构地区：[1]海南医学院国际护理学院,海口市571199

出　　处：《中华护理教育》2023年第9期1100-1106,共7页Chinese Journal of Nursing Education

基　　金：海南省科技专项资助(ZDYF2022SHFZ083);海南医学院研究生创新科研课题(HYYS2021A04)。

摘　　要：目的深入了解妊娠期糖尿病结构化教育干预方案转化为临床实践的促进与阻碍因素。方法采用目的抽样法,对某三级甲等医院7名产科医护人员进行半结构式访谈,采用Colaizzi 7步分析法,辅以NVivo 12软件分析资料。结果从访谈资料中凝练出2个主题,8个亚主题。促进因素包括:明确的课程方案将易于临床应用与推广;持续追踪随访将有效巩固实施效果;医护人员认同变革的临床实践意义;患者对变革的参与度和配合度较高。阻碍因素包括:固定小组线下授课难以开展;多学科团队协作机制有待优化;医院膳食未能满足住院妊娠期糖尿病患者需求;医疗成本投入不足影响变革实施。结论妊娠期糖尿病患者产前结构化教育课程方案在变革和接受者层面的促进因素明确了方案临床实践的可行性,在接受者、组织环境层面的阻碍因素提示方案调整的必要性。由此提示,该干预方案临床转化过程中应关注并纠正障碍因素,进一步优化健康教育资源配置,并从管理层面克服及改善障碍因素。Objective To investigate factors promote and hinder the transforming of structured educational intervention program into clinical practice of gestational diabetes mellitus(GDM).Methods The objective sampling method was employed to conduct semi-structured interviews with seven experts in obstetric care in a third-class A hospital.The interview outline was formulated according to the i-PARIHS framework,and the data was analyzed by Colaizzi 7-step analysis method and NVivo 12 software.Results After analysis,two themes and eight sub-themes were condensed from the interview data.Facilitating factors were as following.Firstly,clear curriculum plan will benefit clinical application and promotion.Besides,continuous follow-up will effectively consolidate the implementation effect.Also,clinical practice significance of the reform should be recognized by the medical staff.Still,the degree of participation and cooperation of patients to the reform is high.Meanwhile,hindrance factors were summarized include difficulty to carry out offline teaching in fixed groups.Multidisciplinary team cooperation mechanism needs to be optimized.Hospital diet fails to meet the needs of hospitalized GDM patients.Insufficient input of medical cost affects the implementation of reform.Conclusion For the program of"Structured Prenatal Education Course for GDM Patients",the promotion factors at the reform level and the recipient level confirm the feasibility of the program’s clinical practice.Meanwhile,the hindrance factors at the recipient level and the organizational environment level suggest the necessity of program adjustment.In conclusion,it is necessary to pay attention to and correct the obstacle factors,further optimize the allocation of health education resources,and overcome and improve the obstacle factors from the management level in the process of clinical transformation of the intervention program.

关 键 词：糖尿病 妊娠 健康教育 定性研究 促进与阻碍因素 

分 类 号：R473.71[医药卫生—护理学]